Cycling Wednesday postponed this week

Comments

1. Dan Walter says

   May 6, 2011 at 7:38 am

   Pro-Publica has a good piece which reiterates the points made in this book: http://collateral-damage.net. Namely, catheter ablation for afib is a corporate-driven procedure and the risks are underplayed.

   • Dr John says

     May 6, 2011 at 11:16 am

     Thanks for commenting, but I disagree.

     Dan, AF ablation is not “driven” by corporations. It’s driven by symptomatic patients with AF, the lack of other treatments, and doctors who want to help.

     • Dan Walter says

       May 6, 2011 at 2:13 pm

       Thank you for not deleting my comment. I did extensive research on the evolution of the procedure, and when it was first being debated there some impressive names in the EP community doubting the efficacy of the procedure and saying that you could not reliably compare the risk/benefit ratio of AA drugs with with an invasive procedure, and that it should not be considered as a first line therapy.

       Now, after tens of millions of dollars spent by device manufacturers, we see that catheter ablation is being promoted as a safe and effective “cure” for afib.

       In fact, the latest study by Haisaguerre, no less, says that the success rate after five years is 29% — and that is being optimistic. “Results in the real world” are probably significantly worse.

       But the procedure is an entrenched money maker. I would be interested in your thoughts on my book, which is well researched and fully documented.

     • Dan Walter says

       May 7, 2011 at 7:52 am

       Dr. John,

       As for being corporate driven, I refer you to the disclosure statement for the landmark study declaring ablation to be a superior alternative to pharmacology: Funding/Support: This study was funded by Biosense Webster, who provided the catheters used.
       Financial Disclosures: Dr Wilber reported receiving grants fromBiosense Webster, Boston Scientific, Medtronic, and St Jude Medical; consulting fees from Biosense Webster, Medtronic, and Sanofi-Aventis; honoraria from Biosense Webster, Boston Scientific, Medtronic, and St Jude Medical; and royalties from Blackwell/Futura. Dr Pappone reported receiving grants and consulting fees from St Jude Medical and Johnson & Johnson, and honorarium from Biosense Webster. Dr Neuzil reported receiving grants from Biosense Webster, Cardiofocus, Cyrocath Technologies, Hansen Medical, NIH BARI 2D, and St Jude Medical; consulting fees from Stereotaxis; and honorarium from Biosense Webster. Dr De Paola reported receiving a grant from Bristol-Myers Squibb. Dr Marchlinski reported receiving grants and honoraria from Biosense Webster, Boston Scientific, and St Jude Medical; consulting fees from Biosense Webster, Boston Scientific, GE Healthcare, Medtronic, and St Jude Medical; and speakers’ bureau fees from Biosense Webster. Dr Natale reported receiving grants from Biosense Webster and St Jude Medical, and speakers’ bureau fees from Biosense Webster, Boston Scientific, Medtronic, and St Jude Medical. Dr Macle reported receiving consulting fees and honorarium from Biosense Webster. Dr Daoud reported receiving consulting fees from BARD and Biosense Webster, and honorarium from Biosense Webster. Dr Calkins reported receiving consulting fees from Ablation Frontiers, Atricure, BARD, Biosense Webster, Boston Scientific, CryoCor, CyberHeart, Medtronic, ProRhythm, Sanofi-Aventis, and TASER International; a grant and honorarium from Biosense Webster; speakers’ bureau fees from Atricure, BARD, Biosense Webster, Boston Scientific, Medtronic, and Reliant; and fellowship fees from BARD, Boston Scientific, and Medtronic. Dr Hall reported receiving consulting fees from Biosense Webster. Dr Reddy reported receiving grants from Atritech, Boston Scientific, Biosense Webster, Cardiofocus, CryoCath Technologies, Endosense Hansen Medical, St Jude Medical, and Stereotaxis; consulting fees from Biosense Webster and St Jude Medical; and honoraria from Boston Scientific, Biosense Webster, Medtronic, and St Jude Medical. Dr Augello reported receiving honoraria from BARD, Biosense Webster, and St Jude Medical. Dr Reynolds reported receiving consulting fees from Biosense Webster, Cardiome Pharma Corp, and Sanofi-Aventis. Mr Vinekar and Ms Liu are employees of Biosense Webster. Drs S. Berry and D. Berry reported receiving consulting fees from Biosense Webster, Veridex LLC, Boston Scientific, Endologix, R.R. Bard, W.L. Gore, Medtronic, Bristol-Myers Squibb, Pfizer, and Teva Pharmaceuticals.

2. Campykid says

   May 6, 2011 at 11:26 pm

   The physicians (2 cardiologists and 3 EPs) I consulted for my AF did not prod me to have an ablation. However, as a very symptomatic and relatively young patient who has failed three anti-arrhythmia medications, I actively sought such treatment after considerable research. My goals were to eliminate, or at least reduce, increasingly frequent episodes and the need for AF medications. I have now had two procedures and view them as treatments, not a cure. If AF returns and I am a good candidate, I would consider having another.

3. Dan Walter says

   May 7, 2011 at 7:46 am

   That’s good. You are an informed and involved patient with thoughtful and apparently conservative physicians. From what I can tell, however, you are an exception. I have a small collection of news stories from around the country announcing that Dr. X at Cardiology Associates in Center City now performs ablations for afib, a minimally invasive procedure that can cure you. Headlines like this: “After Atrial Fibrillation, Woman gets Rhythm Back:
   ‘This can be literally cured… The success rate for the procedure is 90 percent’ ”
   http://collateral-damage.net/news-this-just-in/

   These are just out and out lies propagated by industry. The success rate after five years as optimistically defined by the pioneer of the procedure is 29%.

   I can certainly understand why someone would want to undergo the procedure as a palliative measure. Afib can be debilitating and if your case is symptomatic enough, you might well be justified in trying it just to get a few years of relief.

   But no one can be “literally cured” by ablation.